Provider Demographics
NPI:1134470602
Name:M J A HEALTHCARE OF THE LEHIGH VALLEY P C
Entity Type:Organization
Organization Name:M J A HEALTHCARE OF THE LEHIGH VALLEY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAMONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-4460
Mailing Address - Street 1:796 SEVEN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7940
Mailing Address - Country:US
Mailing Address - Phone:570-872-9800
Mailing Address - Fax:570-872-9888
Practice Address - Street 1:1104 VAN BUREN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2030
Practice Address - Country:US
Practice Address - Phone:610-438-4460
Practice Address - Fax:610-438-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424898174400000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI18217Medicare UPIN